Provider Demographics
NPI:1417486853
Name:DESHMUKH, NICOLE S (MS, MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:S
Last Name:DESHMUKH
Suffix:
Gender:F
Credentials:MS, MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:STIVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO # 84640
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-1100
Practice Address - Country:US
Practice Address - Phone:505-272-4814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11415578-1205207ZP0102X
NMMD2023-1074207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology